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2. medicine
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Surgical
Excellence
No-Scalpel No-Needle Vasectomy
Pollock TechniqueTM Circumcision
Providing
our patients
with the
highest
standard
of
Patient
Care
No-Scalpel No-Needle Vasectomy
Pollock TechniqueTM Circumcision
WELCOME
Our goal at Pollock Clinics is to uphold the highest standards of patient care and surgical
excellence. In keeping with this philosophy and to ensure that all patients are properly prepared
before their vasectomy, we have prepared this manual which is critical for you to review before and immediately after - your vasectomy. You may also view two videos on our website
(www.pollockclinics.com), one of the vasectomy, filmed live, that demonstrates our virtually
bloodless, painless 6 minute procedure, the other of patients describing their positive
experience with us.
W HAT EXACTLY IS A VASECTOMY?
The testicles produce sperm cells that travel into the epididymis, a holding area for sperm. The
epididymis leads into a tube, the vas deferens. The vas deferens or “vas”, as it is commonly
referred to, then continues to travel through the prostate before joining with the vas deferens on
the other side to become the urethra, which exits through the penis. The goal in a vasectomy is
to block the right and left vas (the tubes that carry the sperm cells). You will still have seminal
fluid being ejaculated after your vasectomy (because the fluids are added by the body to the
ejaculate at a different point past where the block is created). But the ejaculated fluid will be
exiting the penis without the small amount of sperm cells normally present. In other words,
your ejaculation will be virtually the same as the pre-vasectomy, because sperm cells are
normally only 5% of the total volume of the ejaculate. The small amount of sperm cells simply
leak out of the lower testicular end of the cut vas, bounce around, break down and get absorbed.
More are then produced and the process repeats itself. As a result, you will ejaculate semen
without sperm. A man cannot make his partner pregnant without sperm.
W HAT IS DIFFERENT ABOUT A NO-SCALPEL VASECTOMY?
-1-
No-scalpel vasectomy is different from a
conventional vasectomy in the way the doctor gets
to the tubes, not in the way he blocks them. In
addition, an improved method of local anesthesia,
the no-needle method, helps make the procedure
virtually painless.
In a conventional vasectomy, after the scrotum has
been numbed with a local anesthetic, the doctor
makes two cuts in the skin and lifts out each tube
in turn, cutting and blocking them. Then the
doctor stitches the cuts closed. In a no-scalpel
vasectomy the doctor locates the tubes under the
skin and holds them in place with a small clamp.
Instead of making two incisions, the doctor makes
one tiny puncture with a special instrument. The
same instrument is used to gently stretch the
opening so the tubes can be reached. This line
accurately represents the actual size of the
puncture (|). Through this tiny opening both tubes
are temporarily lifted out and then blocked, using
heat cauterization.
No-Scalpel
Vasectomy:
Pulling out one
of the two vas tubes
No-Scalpel
Vasectomy:
No stitches are
needed to close
the tiny opening
Conventional
Vasectomy:
Two moderate incisions
stitched closed
P ATIENTS APPRECIATE THE NO-NEEDLE ANESTHESIA (NNA)
With NNA a local anesthetic can be delivered through the skin with an air injector, virtually
painless and very effective without the use of a needle.
B ENEFITS OF DR. POLLOCK’S NO-SCALPEL NO-NEEDLE VASECTOMY.
Studies have shown an eight times lower complication rate, quicker healing and less
intra-operative discomfort for a no-scalpel vasectomy, compared to the more conventional
approach. Not all vasectomy providers prefer this technique because it is much harder to learn
how to do a vasectomy through a tiny 2 mm central opening than it is to make sizeable cuts
requiring sutures.
Dr. Pollock carries out what many studies describe as a crucial step, called fascial interposition.
This step involves tying the sheath or covering of the vas over one end of the cut tube with a
dissolving thread, to create a natural barrier between the two cut ends. There are many different
techniques used to block the vas, even among no-scalpel vasectomy physicians.
With Dr. Pollock’s technique no metal clips are used because of his preference not to leave any
foreign metal objects in the scrotum. The fine tubes are then gently placed back into the
scrotum. No stitches or skin glues are required to close the tiny puncture, which heals without
a scar.
W HAT ARE SOME POTENTIAL BENEFITS OF OPEN-ENDED VASECTOMY?
Dr. Pollock prefers open-ended vasectomy, where the vas tube is cut, the end from the testicle is
left open (uncauterized), while the end of the tube leading to the penis is closed. The open end
of the tube permits sperm to leak out, break down and be absorbed. There may be less
post-operative discomfort because there is no sudden pressure back-up to the testicles.
Vasectomy reversal may also be easier to perform later, if required.
After vasectomy
Semen
contains
no sperm
Vas Tube is cut
Upper end is cauterized
Sheath tied around
upper end of cut tube
The upper ends of the tubes
are closed and sperm is
prevented from reaching
and joining the female
egg cells.
Lower end is left open
Sperm Cells
(leak out, break down
and are absorbed)
-2-
F REQUENTLY ASKED QUESTIONS:
Is there any discomfort?
Before the vasectomy you will not need any sedatives. No-Scalpel No-Needle Vasectomy is virtually
painless. Afterwards you may be sore for a couple of days and should take a mild painkiller, as
outlined on page 8. The discomfort is less with the no-scalpel technique because there is minimal
injury to the tissues.
How soon can I go back to work?
You should not do any heavy physical labour for seven days after your vasectomy. If your job does not
involve this kind of work, you can go back sooner. Many men have their vasectomy on Thursday or
Friday, so they can take it easy over the weekend and go back to work on Monday.
Will vasectomy change me sexually?
The only thing that will change is that you will not be able to make your partner pregnant. Your body
will continue to produce the hormones that make you a man. You will have the same amount of
semen. Vasectomy won’t change your voice, beard, your muscles, your sex drive, your erections, or
your climaxes. Some men say that without the worry of accidental pregnancy and the bother of other
birth control methods, sex is more relaxed and enjoyable than before.
Does No-Scalpel Vasectomy work?
In Dr. Pollock’s hands it has been extremely effective! In fact, Dr. Pollock’s success rate has been
better than 99.9%, which is amongst the highest in North America.
Will I be sterile right away?
No, after a vasectomy, there are always some active sperm in your system. It usually takes three
months plus 20 ejaculations to clear them. You and your partner should use some other form of birth
control until two semen tests confirm that your semen is sperm free.
Is No-Scalpel Vasectomy safe?
Most medical experts, including special panels convened by the National Institutes of Health and by
the World Health Organization, have concluded that vasectomy is a safe and simple procedure.
Vasectomy is surgery, and all surgery has some risks, such as bleeding and infection. But serious
problems are uncommon.
Can a No-Scalpel Vasectomy be reversed?
Yes, but reversal operations are expensive and not always successful. If you are thinking about
reversal, perhaps vasectomy is not right for you. Pre-vasectomy Sperm Banking (cryopreservation) is
a good idea for almost anyone considering a vasectomy. Ask our staff for details.
How much will a vasectomy cost?
The B.C. Medical Services Plan covers vasectomy and the tray fee. Our new, optional Premium
Uninsured Services Package is available for enhanced convenience and personalized services.
When can I start having sex again?
-3-
As soon as you are comfortable, after a minimum of seven days, but remember to use some other
kind of birth control until your semen analysis confirms you are sterile.
A BOUT DR. POLLOCK
Dr. Neil Pollock is the largest vasectomy provider in BC. His entire practice is unique in that it
is limited to two surgical procedures, one of which is the no-scalpel no-needle vasectomy.
Dr. Pollock reports an outstanding success rate of over 99.9% in the last 15,000 surgeries - his
success rate is related to the technique he uses to block the tube (as illustrated in this handout),
as well as to the large volume of vasectomies he performs, which has allowed Dr. Pollock to
become highly proficient at the procedure.
Dr. Pollock introduced the combination technique of “No-Scalpel No-Needle No-Metal Clips
Vasectomy in Canada. He has been a frequent guest lecturer at hospitals and conferences, both
locally and nationally.
Dr. Pollock performs vasectomies at Pollock Clinics’ New Westminster and West Broadway
locations, he does not use local hospitals because that would mean a long wait for you to have
the procedure. By setting up his own private surgical centres, Dr. Pollock has created a
convenient situation for patients - you can be seen for your consultation and have your surgery
within just days or weeks of calling the office.
Dr. Pollock understands the anxiety some men may experience when considering vasectomy. To
alleviate their concerns, he has filmed and posted his virtually bloodless, painless technique
(with audio) for all interested patients to view. This video is posted on his web site, at
www.pollockclinics.com
a leading resource for information on vasectomy. Here you can also read the commentaries of
leading surgeons who refer to Dr. Pollock’s work as ‘elegant’ and ‘the perfect vasectomy’, and
who call Dr. Pollock ‘one of Canada’s master vasectomists’.
T ESTIMONIALS
Please see the patients’ testimonial video, also on the website, where past patients tell you
first-hand about their experience at the Pollock Clinics. Patients’ comments include:
“It was great, virtually painless, comfortable and very quick.” Jon - Vancouver
“Dr. Pollock is at the top of his game. Great rapport and bedside manner.” Bob - Surrey
“Grace and staff were friendly, helpful and professional, which eased the whole process.”
Dave - Kamloops
TIMING
It’s best to get a vasectomy when you and your partner are sure that you are happy with the
number of children you have. If you have a child under six months of age, you might want to
wait because of ‘Sudden Infant Death Syndrome’, a condition where a child can die after a few
months of life for no apparent reason. This might possibly affect the timing of your plans for
vasectomy.
-4-
T HE POLLOCK CLINICS EXPERIENCE
On the day of your surgery you will be asked to come a few minutes early for your appointment.
Our staff usher you into one of the surgical rooms, which is equipped with a CD player.
You are welcome to choose music from a selection of CDs.
You are not required to fully undress, you just need to lower your pants, lie back on the table and
relax. One of Dr. Pollock’s assistants places an elastic around your penis to bring it out of the
operative field, washes the scrotal area with iodine solution and places surgical towels on your
body. Dr. Pollock then enters and puts a small amount of freezing into the skin. The vasectomy
takes approximately six minutes. Afterward, you will be brought back to the waiting room
where you will receive a cold drink and have time to relax. When given the thumbs up you can
drive yourself home.
P REMIUM SERVICE OPTION
B.C Medical Insurance covers the basic vasectomy. For patient comfort and convenience,
our office can provide, at additional cost, an optional Premium Uninsured Services Package,
which has become a popular choice among our patients.
1.)
All supplies you need to purchase for before and after your surgery are pre-bought,
pre-packed and given to you at surgery, so it saves you the inconvenience of having to run
around to different stores to buy these items before surgery.
2.)
All your follow up visits will be done by telephone. So, rather than having to come
back to the office multiple times and dealing with the time lost from work, driving, parking,
gas, waiting, etc., we will do everything by telephone with you, saving you all the
inconvenience. This includes giving your semen test results by telephone. All this will save
you 6-8 hours of time.
3,)
MSP covers the basic vasectomy, with the traditional needle freezing to the scrotum.
With premium service, we offer the No-Needle freezing device that Dr. Pollock acquired
from the US. With this device we are able to administer freezing without the use of a needle
using only air pressure and xylocaine. Many of our patients find this approach more
comfortable and less anxiety provoking.
Most of our patients really appreciate this option and say "I am going to do this once in my
life, I want to have the simplest, most convenient and most comfortable option that is
available" and that is why they choose the premium service.
Should you choose not to purchase the Premium Service option, you will be required to
come back to the office in person for all the follow up visits, test results, etc. We will provide
you with a list of the supplies you will be required to purchase on your own and you will get
needle freezing of the scrotum.
P OST VASECTOMY
-5-
You need to follow the instructions in the ‘After your vasectomy’ section exactly as written, as
this is the best way to minimize the risk of complications - failing to do so could delay your
recovery from just days to weeks or months. Specifically keep in mind that if you do light work,
(i.e. you have a desk job), you could have your surgery done Thursday or Friday and go back to
work Monday. If you do heavy work that consists of lifting anything greater that 15 lbs., bending,
stretching, operating heavy machinery, getting in and out of cars, going up and down stairs
and/or being on your feet a lot, you really should take seven days off work. In addition you
should ask for a note for ‘light duties only’ for the second week after you return to work.
AFTER YOUR VASECTOMY
A few hours to a few days
- There may be a small amount of bleeding.
- It is normal to feel some discomfort in your scrotal area. Some men describe it
as like a kick in the scrotum. You may feel this discomfort in you lower abdomen
as well.
Day of vasectomy
- Go home and rest lying down for the remainder of the day end evening.
- Put the antibiotic ointment on the gauze and change the gauze twice a day. Do
this until there is no more blood, then just wear the support over your underwear
without the gauze.
For the first 48 hours
- Take 2 tablets of extra-strength Tylenol every 5 hours.
- Ice the area 20 minutes every hour (except while you are sleeping).
- Avoid alcohol.
After 48 hours
- Continue to ice the area every evening for another 5 days.
- Take 2 tablets of Ibuprofen (400 mg) every 6 hours (maximum 8 tablets per day),
no matter how good you feel. If you get side effects, then of course, stop the pills.
For 7 days
- Wear the scrotal support over your underwear all the time (except while you are
sleeping), unless it is uncomfortable.
- No bathing or swimming (showers only).
- No sex or ejaculation.
- Take it easy. No lifting more than 15 lbs. (including babies and children). No
exertion,no exercise, no extensive walking/climbing, no sports (golf, hockey, hiking,
etc.) - you get the idea.
-7-
3 days after each test call our office to get your test results.
R ISKS AND POSSIBLE COMPLICATIONS
- Most men report a bruised sensation to the scrotum for a few days to a week after
the procedure.
- Some men experience mild bleeding into the scrotum (1/100).
A small, tender swelling may form for a few days.
- Scrotal hematoma (1/2000).
A major bleed into the scrotum could occur, causing a grapefruit size tender scrotum,
disabling you for two months. You should call Dr. Pollock immediately at 604.644.5775
if you notice significant swelling in your scrotum after your procedure.
- Infection which may require antibiotics (1/100).
More serious infection is possible, ie. an abscess formation that may require
intravenous antibiotics.
- Epididymitis (1/50).
Tender swelling of the epididymis, which is the the part of the tube that joins to the
testicles. It almost invariably resolves with anti-inflammatories, ice and rest.
- Sperm granuloma (1/500).
A painful lump made of leaked sperm that develops at the site where the tube was
blocked. It almost invariably resolves with anti-inflammatories, ice and rest.
- Post vasectomy pain syndrome (1/1000).
A rare complication of pain in the testicles that can persist for months or years and
may be quite debilitating. Some men may never completely recover from this problem
or it may resolve on its own or another surgical procedure may be required.
- Other complications have been reported. (1/10,000)
- Some studies have reported a small increase in prostate cancer after vasectomy.
Many other studies have shown no increased risk. Most experts agree that vasectomy
does not cause cancer.
- Late failure (1/3000).
A rare outcome for men who, even after a successful vasectomy with two semen
analyses showing no moving sperm, still manage to impregnate their partner.
-9-
Call the lab of your
choice 2 weeks in advance and book your test (post vasectomy semen analysis).
When dropping off your sample, you must bring your lab forms with you.
Failing to do so will result in the lab not accepting your sample.
No-Scalpel No-Needle Vasectomy
Pollock TechniqueTM Circumcision